This method handles extraneous item => Zabbix::API::Item attributes in the gitems array, transforming them into itemid attributes, and pushing the items to the server if they don't exist already. The original item attributes are kept but hidden from the CRUDEpush method, and restored after the pull method is called.

This means you can put Zabbix::API::Item objects in your data and the module will Do The Right Thing (assuming you agree with my definition of the Right Thing). Items that have been created this way will not be removed from the server if they are removed from the graph, however.